My doctor thinks I probably have SIBO, but hasn't offered anything specific to change, for my diet. Although I began with a prescription treatment, I do still have symptom s of bloating. Is this diet related? -Susan, North Hampton

ANSWER:

By: Dr. Anthony Lembo, Division of Gastroenterology, BIDMC Food can be a cause of bloating in some individuals, particularly poorly absorbed carbohydrates sometimes referred to as FODMAPs (fermentable oligo, di, monosaccharides, and polyols). A low FODMAP diet has been reported to improve bloating symptoms in some individuals.

QUESTION:

I have been having 'gut' problems for 3 weeks now. My symptoms range from a belly ache to severe pain in my upper back behind m y rt. breast with pain that radiates around the side to just under m y breast, sometimes making it difficult to take a deep breath. I've also experienced acid heartburn. I have taken dairy out of my diet, limited wheat consumption, no raw vegs. or fruit & a pretty bland diet. I have had ultrasound that showed m y gall bladder was fine, multiple blood work...everything was negative. Everything settled down for about 4 days but the severe breast/back pain has happened about 6 times in the three weeks. My doctor put me on IC OMERPRAZOLE DR 20 MG BID & IC SUCRALFATE 1 GM TID. I lost about 6 lbs, not bad, since I am 5'8" & weigh 190 lbs, but not happy on how I am losing it. My PCP has said that if this continues I may need to get endoscopy. Do you have any advice on where I should go from here? -Muriel, Wakefield

ANSWER:

By: Dr. Jacqueline Wolf, Division of Gastroenterology, BIDMC There are 3 possibilities that are most likely causing the problems.

1. Acid reflux might be causing all of these problem. The omeprazole would help.

2. Ulcerations or inflammation of the stomach or the duodenum could be causing the problem. This could be due to an infection with a bacterium called Helicobacter pylori or to taking drugs like aspirin or ibuprofen or naprosyn.

3. The other possibility is gallbladder disease. Gallbladder disease may have abnormal liver tests or may not. Usually it is associated with gallstones. If you have not had a gallbladder ultrasound or function scan of the gallbladder, you should have them. If you continue to have heartburn on the omeprazole, yes, you should have an upper endoscopy to see what might be going on in the stomach or esophagus.

QUESTION:

What causes creatine to elevate and what foods lower it? -Elizabeth, Braintree

ANSWER:

By: Lauren Fay, Dietician, BIDMC

Creatine is found in high protein foods like meat, chicken, and fish, or supplements often sold at health food stores. Creatinine (a lab value often measured as part of a routine health assessment) is produced when creatine is broken down for energy in our body, so limiting protein sources in your diet could potentially decrease this value. However, there are many other reasons a creatinine level could be elevated in your blood including dehydration or kidney dysfunction. Adequate protein intake in your diet is required to maintain lean body mass (muscle), and we often require increased amounts of dietary protein during times of recovery from illness or surgery in order to heal properly. It would not be advised to limit protein sources in your diet prior to consulting a physician or registered dietitian to better understand what is causing an elevated creatinine level.

QUESTION:

What causes creatine to elevate and what foods lower it? -Elizabeth, Braintree

ANSWER:By: Lauren Fay, Dietician, BIDMCCreatine is found in high protein foods like meat, chicken, and fish, or supplements often sold at health food stores. Creatinine (a lab value often measured as part of a routine health assessment) is produced when creatine is broken down for energy in our body, so limiting protein sources in your diet could potentially decrease this value. However, there are many other reasons a creatinine level could be elevated in your blood including dehydration or kidney dysfunction. Adequate protein intake in your diet is required to maintain lean body mass (muscle), and we often require increased amounts of dietary protein during times of recovery from illness or surgery in order to heal properly. It would not be advised to limit protein sources in your diet prior to consulting a physician or registered dietician.

QUESTION:

I have fecal incontinence and recently had a stim-implant. Some days it works and other days I still suffer because I am gluten and lactose intolerant. How important is it that I stay close to my diet and how does it effect by stimulator? Usually on a good day I have a bowel movement in the morning if I've taken a fiber drink night before and then after several movement, it turns into diahrea and then the stim does not work. What can I do? -Joan, Waltham

ANSWER:

Dr. Jacqueline Wolf, Department of Gastroenterology, BIDMC If you have diarrhea then even a person with a normal pressure in the anus cannot always prevent fecal incontinence. Therefore it is very important to stick to a diet if you get diarrhea from certain foods. The stim-implant helps. However, the diarrhea can be loose and come fast and therefore the stim-implant won’t always work.

QUESTION:

I had a bypass done to my celiac artey from an auto accident injury. Could the LINX surgery be done to treat acid reflux where it would not affect this? I have been told that my stomach cannot be shifted with the bypass being there. -Paul, Raynham

ANSWER:

Dr. Michael Kent, Division of Thoracic Surgery, BIDMC

You may be a candidate for the LINX procedure. But first you would need to set up an appointment so we could review your medical history before making a definitive decision. To schedule an appointment, please call 617-632-8100 or email surgicalreflux@bidmc.harvard.edu

QUESTION:

I have had bloating for four years (four inches of bloating, to be exact). I look as though I am 6 months pregnant. Three GI specialists later, all tests have been normal- colonoscopy, endoscopy, breath test, GYN exploratory surgey, a lot of antibiotics, entocort (worked great for a month), celiac tests, and Crohn's tests. I have been put on Bentyl for muscle spasms. It seems to help but as it wears off my abdomen twitches and spasms more. I have stopped taking it because of this. Should I continue with it? -Lori, New Hampshire

ANSWER:

Gas can be due to a number of different causes although many of these have been ruled out with the testing you have undergone. Although the Bentyl sounds as though it is helping, you should contact the doctor who prescribed it if you have having side effects of twitching and spasm. There are additional medications that can be tried. Also, there are a number of over the counter anti-gas agents such as Beano and activated charcoal tablets that can be helpful but again, you should check first with your physician. If I can be of help, I would be happy to see you in my office at 617 667 5576.-Steven D. Freedman MD, PhD Chief, Division of Translational Research Director, The Pancreas Center, BIDMC.